AI Article Synopsis
- - The study focused on patients with cardiogenic shock (CS) and evaluated the impact of pulmonary artery catheters (PACs) on their clinical outcomes, specifically in-hospital mortality rates and use of advanced therapies.
- - Analysis of 1,043 patients revealed that those receiving PACs had a lower in-hospital mortality rate (29.3% vs 36.2%) and were more likely to receive advanced heart failure treatments, such as mechanical circulation support.
- - The findings suggest that PACs are beneficial in managing CS, particularly for patients in more severe stages (SCAI D and E), though their use was also linked to longer stays in intensive care and hospitals.
Article Abstract
Background: Hemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs).
Methods: We included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay.
Results: A total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs.
Conclusions: Among patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.
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| http://dx.doi.org/10.1016/j.cjca.2023.12.005 | DOI Listing |
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